Jean Marie Antonucci, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

12782 Issued in ME

Practice address

115 Mt Blue Cir
Ste 2
Farmington, ME 04938-6239

Phone

(207) 778-3313

Fax

(207) 778-3544

NPI assigned

Jun 27, 2005

Last updated

Nov 15, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Temple University School of Medicine, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Penobscot Community Health CenterGroup PAC ID 0143212670, 135 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Penobscot Community Health Center

  dba Penobscot Community Health Care

  • Federally Qualified Health Center (FQHC)
  • Bangor, ME
  • NPI 1427169010
  Medicare reassignment Care Compare group
• Rockomeka Family Practice LLC

  • Rural Health Clinic/Center
  • Livermore Falls, ME
  • NPI 1871568766
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321315200000",
    "number": "1356347900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 MT BLUE CIR",
            "address_2": "STE 2",
            "city": "FARMINGTON",
            "state": "ME",
            "postal_code": "049386239",
            "telephone_number": "207-778-3313",
            "fax_number": "207-778-3544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 MT BLUE CIR",
            "address_2": "STE 2",
            "city": "FARMINGTON",
            "state": "ME",
            "postal_code": "049386239",
            "telephone_number": "207-778-3313",
            "fax_number": "207-778-3544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONUCCI",
        "first_name": "JEAN",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-27",
        "last_updated": "2011-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "12782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LISENSE",
            "identifier": "12782",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "048285",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "298980000",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suzanne Alexis, PMHNP-BC
• Allied Physical Therapy
• Colleen S Andrews, CCC-SLP
• Timothy William Andrews, ATC, LAT, NREMT-B
• Taylor Antanavich
• Susan A Anzivino, PHD
• Rebecca Atwood, OT
• Tara A Aumand, M.D
• Katelyn M Bachelder
• Kristie A Backus, LCPC-CC

• Family Medicine Physician in Farmington, ME
• Providers in Farmington, ME by specialty
• Family Medicine Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.